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Q&A: Al Russell

The chief executive of The London Clinic on its distinctive culture, listening to staff, and the impact of commercial innovations on clinical care

Interview: Viel Richardson
Portrait: Orlando Gili

Your background was in the telecommunications industry. What led you to make the switch to healthcare?
My first role with The London Clinic was as a trustee. At the time the hospital was making a lot of IT decisions and also looking for some commercial oversight. Working as a trustee, I soon began to realise there was something quite special here. I felt real satisfaction from the tangible benefits the work delivered. We would talk about things in a room, and they would make a real difference to patients in our hospital corridors. When the chance arose to become the CEO here, it was a ‘yes’, as I feel I can make a difference in a very tangible way.

What differences did you find from more corporate cultures?
Some things that were second nature to me were new to the organisation. There are structures and processes you will find in most large businesses—commercial things, what we call ‘process points’—that aren’t as widespread in our hospital departments. It has been good to impart those ways of thinking into the organisation, and see the benefits begin to accrue.

I want to ensure that The London Clinic maintains its status as the leading independent general hospital with charitable status in central London, in an increasingly competitive field. We will do that by maintaining clinical excellence while improving our efficiency in non-clinical areas. It’s important to stress: that does not mean simply looking for savings, but finding more effective processes and structures.

How will you set out achieving this?
To give one example, any hospital generates a vast amount of information, and using this efficiently and effectively is key: registering patients, logging return visits, having clinicians access patient records and interrogate the data they have collected. One of the things that is very different in the world of telecommunications is the approach to data. There are real advances to be made throughout our hospital.

Can improving this ancillary work directly improve clinical outcomes?
Yes, these processes can definitely improve on the delivery of clinical services. Every minute we can shave off booking patients in, booking theatre slots or sorting out radiology appointments is extra time that our consultants can spend with patients. I want those structures to be razor-sharp. It is quite unglamorous, but it can provide huge benefits.

What have been the most challenging aspects of your work?
I think because of my background, I am wired for speed. I am finding myself having to adjust to the slightly different pace of this industry. I sometimes want things to happen more quickly than they do! I am very ambitious for this place. The market is moving so quickly, and we cannot afford to stand still; we need to make use of our independence to be more fleet of foot.

Of course, clinical decisions take their own time, and that is not something I’m going to get involved in. But I do sometimes feel that the clinical pace dictates the pace of everything else, including ancillary practices that could be done better and more efficiently. It’s about balancing speed with good practice. Which processes can we speed up without compromising patient safety or clinical excellence? We are already on the right path, but there is further to go.

How do you approach the clinical side of your role?
I have spent a lot of time listening. We have many very loyal staff who understand and respect the culture of this hospital and I have asked their views on a range of issues. Based on this, we have formulated a strategy which has three areas of focus. One is surgery, in particular relating to digestive diseases. Another is our musculoskeletal work—we have a very strong rehabilitation facility here. The third is based around patient management, and our multidisciplinary teams (MDTs), especially in cancer care.

These MDTs are a key part of how we operate. One of our goals is that whenever a patient has a procedure, we want them to return for their follow-up treatment. That is good for the patient, it is good clinical governance, and it is good for our business. We should not hide from the commercial side, especially as we are a charity, so all the money that we generate goes back into the hospital.

What commercial changes are you making?
This is all about commercial agility, and our commercial agility will underpin our clinical pillars. The London Clinic is an independent organisation with a unique ethos: caring, collaborative, friendly and specifically not corporate. To maintain that, we need to keep delivering outstanding patient outcomes, and attract more patients. We need to be open-minded about joint-venture relationships with our consultants—who are also in a way our customers. We need to be more competitive with pricing for self-paying patients. We need to be better at sharing our stories, because we have such a wonderful narrative. And we need to be much more open-minded about partnerships with other institutions, so that we can compete with the really big commercial players in the market.

Historically, this is not something the hospital has engaged in, and I think it has cost us. You do need to choose carefully, because often you will be collaborating with competitors, but the net benefits that both parties can accrue can be huge. Those commercial opportunities have always been there—I’m saying we should simply be alive to the ones that will benefit us most.

What other areas are you looking at?
Digitising data in ways that help the patient is key. So, for example, allowing the patient to log on and see aspects of their records, and helping them to understand the kind of questions they should be asking about how they are feeling and their recovery. Doing that well means the patient feels more connected with their treatment and feels like they are in one hospital as they go through the different areas. Clinical excellence is another key area of our strategic plan. Last year, over 700 audits took place to ensure we are giving patients the very best personalised care. This includes ensuring nurse to patient ratios are strengthened.

It seems your staff are central to your strategy.
Good strategies are born of an environment in which people feel they can innovate. For example, we will be asking our front-line employees how we change our processes for the benefit of our patients. Their job is about so much more than answering phones. They’re the mouthpiece of the organisation; they’re often the first experience of us that people have. They can greatly improve the public’s perception if we enable them to do so.

In my experience, those who have the closest proximity to the customers are often the best informed about how to improve things, but have the least power to make those ideas happen. I was involved in reversing that in a very large organisation, and I want to do that here, too. It’s often the small things that made the biggest differences to our patient experiences; it is not always about buying huge pieces of kit. This type of engagement is very motivating for everyone involved and can deliver very powerful results.

Is clinical innovation important as well?
Very much so. Recently we did some pioneering work with Mr Erlick Pereira on deep brain stimulation, an innovative treatment for Parkinson’s disease. Mr Dinesh Nathwani is breaking new ground with very low-invasive knee surgery, using a new robotic system. We are creating small groups of consultants to look into clinical innovations in their fields. This kind of innovative thinking is not only great for our patients, but good for our commercial side.

Are you also investing in new technology?
We have a new Siemens Vida 3T MRI scanner coming online soon, which will provide gold standard imaging support in speciality areas such as orthopaedics, oncology, urology and neurology. We will be the first hospital in London to have one. On a smaller but no less important scale, we have bought more scopes for the endoscopy unit, which gives the unit more capacity and flexibility. There will be many such investments going forward.

What are you enjoying most about the job?
I have got to know a lot of really talented and committed people in a short space of time, which has been fun. But mainly the fact that the decisions I’m making are having a beneficial impact on our patients. It is a nice feeling to take home at the weekend.